How Does Vyvanse Work for Depression?

Amphetamines (Dexedrine, Adderall) are sometimes used as a last-resort option for treatment-resistant depression. Vyvanse is an amphetamine pro-drug; once in the body, it is converted to d-amphetamine, and thus may be used in place of older amphetamine preparations for this purpose.

Chemistry

• Most antidepressants, including SSRI's and the older tricyclic family of antidepressants affect primarily the neurotransmitter serotonin. Vyvanse affects primarily dopamine and norepinephrine.

Mechanism of Action

• Dopamine is the primary neurotransmitter at work in the brain's reward and goal-seeking circuits. Vyvanse inhibits the reuptake of dopamine (and to a lesser extent norepinephrine), "amplifying" the effects of these circuits.

Subjective Effects

• By manipulating the brains reward and goal-seeking circuits, Vyvanse stimulates general motivation and reverses anhedonia (the inability to take pleasure in normal activities).

Efficacy

• Amphetamines in general will cause immediate therapeutic response in most depressive patients. Amphetamines are short-acting drugs, however, and as the dose leaves the system, the rebound depression will usually be more intense than the base-line depression. Persistent dosing is not possible as tolerance to Vyvanse will increase rapidly.

Dangers

• The dose size of Vyvanse necessary in the treatment of depression must continually rise as tolerance develops. At some point, amphetamine psychosis will become an issue due to the large dose. Suicide is also always a risk, particularly during the "crash" period.